Migrants fleeing conflict: a trial run for mass-migration due to climate change

Refugees_Budapest_Keleti_railway_station_2015-09-04
Refugees, Budapest station, Hungary. Credit: Rebecca Harms
(http://creativecommons.org/licenses/by-sa/2.0)
via Wikimedia Commons

 AS I write this I have a sense of déjà vu.
Public health professionals as far back as the 6th ECTMIH conference [2009], which I attended, recognised that very little was being done in Europe to address mass migration (at that time from Sub-Saharan Africa). Travel medicine specialists were refocusing their research onto migration and asking why this was not being reflected in travel medicine text books and journals.

“Does anyone ever ask if migrants suffer from diarrhoea?” asked Manuel Corachan [CRESIB, Spain], one of the plenary lecturers at the conference.  

At that time, Italy (conference host) was bearing the brunt of illegal migration. The conference debated the needs of illegal migrants to Italy, the importance to public health in the host country of giving them access to health services and of having an awareness of disease prevalence & cultural attitudes in the migrant’s home country.  In 2011, the  organisers of ECTMIH , the Federation of European Societies for Tropical Medicine and International Health (FESTMIH) devoted the entire conference to “global change, migration & health”. 

But this foresight was not just ethically driven, it was in expectation of mass migration into Europe due to climate change.

What we are now seeing, less than 6 years later, headlining our daily news and social media is a trial run for what is to come. What was previously perceived as a problem arising out of climate change has hit the EU earlier than might have been anticipated because of people fleeing conflict and dictatorship.

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E. coli O104: Should we believe them this time?

Sprouting peas on tweezer small

Choose your sprouts carefully

Apparently its now thought that fenugreek seeds sourced in Egypt were the cause of the recent outbreaks in Germany and France. I suggest you read today's Update on E.coli O104 outbreaks from EFSA and draw your own conclusions.

The update tells us that the particular batch of fenugreek seeds has been withdrawn from sale and a temporary ban placed on importing fenugreek and certain seeds, beans and sprouts from Egypt. In the case of the seeds, its only if these are to be sprouted. Ground spices are unaffected.

And I quote, "evidence linking the two outbreaks to the implicated batch of fenugreek seeds is not definitive and investigations are continuing in all European countries".

Germany scores own goal…its not Spanish cucumbers!

It's not cucumbers, it might be beansprouts? E. coli O104 has killed 22 people so far, made over1400 ill and reached 11 countries. It has had a significant effect on two countries- damaging Spain’s economy and damaging the credibility of the German public health system. The fallout is broader still:  the EU – and that includes us - is now offering compensation to Spanish farmers – using a central fund. 

For the bewildered public, the clue is in the name Escherichia coli…coli, Latin for intestine; for these bacteria live in the gut of man and warm-blooded animals. Unfortunately, some strains (STEC/VTEC, see Outbreak of E. coli acronyms in Germany) produce toxins that can cause severe diarrhoea, and this is always down to someone’s lack of hygiene.
Not washing hands after defecation, using a water supply contaminated with faeces to wash or water crops or poor manure preparation. It’s transmitted because poo was on your fingers or on your food and went into your mouth!

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Why Washing Your Vegetables and Hands May Not Protect You from E. coli, Staphylococcus, Salmonella…?

Following the recent outbreak of E. coli food poisoning in Germany that claimed at least 37 lives as of 14 June 2011 and still counting, numerous articles have been written, but many fundamental questions still remain unanswered.

As you will remember, contaminated Spanish cucumbers were initially blamed for the outbreak of E. coli infection, which prompted the Spanish government and farmers to vehemently deny this claim (justifiably, as it turned out) and demand compensation.

As soon as “the Spanish cucumber story” was shown to be a false alarm, tomatoes, salad and vegetable sprouts (of German origin) were declared as potential culprits. It is unclear why other vegetables, such as peppers, courgettes, mushroom, to list but a few, were kept off the list of suspects, particularly because all the laboratory tests performed so far have been inconclusive.

As time goes by, it is less likely that the source(s) of this outbreak will be identified any time soon. However, even if a contaminated vegetable (or various vegetables) is identified and successfully linked with this outbreak of E. coli in humans, identifying the pathway of contamination may prove more difficult.

While looking for potential sources of vegetable contamination with pathogenic microorganisms, I searched CAB Direct database and came across a very interesting review published 20 years ago by German Professor Strauch of the Institute of Animal Medicine and Hygiene, University of Hohenheim, which explains how pathogens may contaminate food crops. He warned about the potential of pathogenic organisms to cross from manure or sewage into food crops and suggested that “the agricultural utilization of hygienically dubious sewage or sludge poses a risk for the whole national economy.”

In his 1991 review “Survival of pathogenic microorganisms and parasites in excreta, manure and sewage sludge” (Rev Sci Tech. 1991 Sep;10(3):813-46), Strauch also reported that two groups of researchers had found that pathogenic organisms can be taken up by crops that are used in human and animal nutrition.

Once pathogenic microorganisms are incorporated into crops (including vegetables), washing the outside of fresh vegetables is of little benefit, because all the pathogens from the sludge (bacteria, viruses and parasites) are inside the plant.

Outbreak of E. coli acronyms in Germany

Cucumberscottbsauerusda
Germany seems to be suffering an outbreak of acronyms alongside an unusual outbreak of foodborne E. coli. Reports list the culprit as STEC, EHEC, VTEC, shiga toxin producing E. coli, verotoxin producing E. coli….They are all talking about the same thing.

Heres a quick guide to E coli diarrhoea acronyms and a summary of the outbreak plus some resources…(Photo: USDA)

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